Quick Answer
Fibromyalgia causes widespread pain, fatigue and 'fibro fog' — it's a central sensitization disorder, not imagined pain. Multimodal treatment helps.
Medically reviewed by Dr. Jitendra Prasad Yadav • NMC 8029 • Kathmandu Neurology Clinic & Cognitive Center
Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbances and cognitive symptoms ('fibro fog'). It is a central sensitization syndrome — the brain and spinal cord amplify pain signals, processing normal stimuli as painful. It is a real biological condition, not a psychological one, though psychological factors influence severity.
Diagnostic criteria
Widespread pain (both sides of body, above and below waist) for >3 months, plus fatigue, unrefreshing sleep, and cognitive symptoms. Tender points (9 of 18 specified points painful on palpation) support but are no longer required for diagnosis (2016 ACR criteria use WPI and SSS scores).
Pathophysiology
Central sensitization: amplified pain processing in the CNS, abnormal neurotransmitter levels (low serotonin, dopamine, norepinephrine; high substance P), genetic predisposition, triggers (infection, trauma, stress). Comorbidities: IBS, TMJ, chronic fatigue syndrome, mood disorders.
Treatment
Multimodal approach: aerobic exercise (graded, low-impact), CBT for pain coping, sleep hygiene, medications (duloxetine, milnacipran, pregabalin — FDA-approved for fibromyalgia), and addressing comorbidities. Opioids are generally avoided. Patient education that fibromyalgia is real and manageable is crucial.
When to seek professional evaluation
Fibromyalgia is diagnosed by clinical criteria after excluding other causes — treatment is multimodal and requires patience.
This guide is educational and does not replace individual medical advice.
Frequently asked questions
Answers reviewed by Dr. Jitendra Prasad Yadav • MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM • NMC 8029
Supplements only help when a deficiency is present; underlying cause-directed care is needed.
If the underlying cause is corrected early (e.g., improving glucose control, treating vitamin deficiency), improvement may occur. Long-standing neuropathy is often not fully reversible.
Migraine is a neurological condition; headache is one feature. Associated symptoms and functional impact are important for diagnosis.
Aura refers to visual, sensory, or speech symptoms that precede the headache in some people. Both types are migraine; the presence of aura may influence management discussion.
More: All FAQs → · Ask Dr. Jitendra →
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References & Review
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-11-10
- International Classification of Headache Disorders, 3rd edition (ICHD-3).
- Harrison's Principles of Internal Medicine — Neurology sections.
- American Academy of Neurology guidelines for selected conditions (where applicable).
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.